Office Ergonomic Injury Incident Report
Employee Information
Name
Employee ID
Department
Supervisor
Incident Details
Date of Incident
Time of Incident
Location
Description of Incident
Body Part Affected
Type of Ergonomic Injury
Witness Statement (if any)
Witness Name
Contact Info
Witness Statement
Corrective Action
Describe any corrective action taken or recommended
Reported By
Report Date